Minimally Invasive Redo Aortic Valve Replacement: Results From a Multicentric Registry (SURD-IR).

Santarpino, Giuseppe; Berretta, Paolo; Kappert, Utz; Teoh, Kevin; Mignosa, Carmelo; Meuris, Bart; Villa, Emmanuel; Albertini, Alberto; Carrel, Thierry P.; Misfeld, Martin; Martinelli, Gianluca; Phan, Kevin; Miceli, Antonio; Folliguet, Thierry; Shrestha, Malak; Solinas, Marco; Andreas, Martin; Savini, Carlo; Yan, Tristan; Fischlein, Theodor; ... (2020). Minimally Invasive Redo Aortic Valve Replacement: Results From a Multicentric Registry (SURD-IR). The annals of thoracic surgery, 110(2), pp. 553-557. Elsevier 10.1016/j.athoracsur.2019.11.033

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BACKGROUND

Reoperation for aortic valve replacement can be challenging and is usually associated with an increased risk for complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis.

METHODS

From 2007 to 2018 data from 3651 patients were retrospectively collected from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry. Of them, 63 patients who had previously undergone cardiac surgery represented the study population. In-hospital clinical and echocardiographic outcomes were recorded.

RESULTS

Mean age of the selected 63 patients was 75.3 ± 7.8 years and logistic EuroSCORE 10.1. Surgery was performed by ministernotomy in 43 patients (68.3%) and by anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received the Perceval valve (Livanova PLC, London, UK) and 32 (50.8%) the Intuity valve (Edwards Lifesciences, Irvine, CA). Mean cross-clamp time was 57.8 ± 23.2 minutes and cardiopulmonary bypass time 95.0 ± 34.3 minutes. Neither conversion to full sternotomy nor in-hospital deaths occurred. Postoperative events were ischemic cerebral events in 3 patients (4.8%), need for pacemaker implantation in 2 (3.6%), bleeding requiring reoperation in 5 (8.9%), and dialysis in 1 (1.6%). Median intensive care unit stay was 1 day, and median length of hospital stay was 10 days. On echocardiographic evaluation 1 patient showed a significant postoperative aortic regurgitation.

CONCLUSIONS

Minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis is a safe and feasible treatment strategy, resulting in fast recovery and improved postoperative outcome with no mortality and an acceptable complication rate.

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